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Text File  |  1993-10-10  |  3KB  |  56 lines
  1. 800# SERVICE REQUEST FORM
  2. ______________________________________________________________________
  3. CO. NAME>                                                               CONTACT>                                      TITLE>
  4. STREET ADD>                                                                                                                 COUNTY>
  5. CITY>                                                                                              STATE>                                ZIP>
  6. BILLING ADDRESS, IF DIFERENT FROM ABOVE>
  7.  
  8. BUSINESS BANK>                                                                  BRANCH>                        ACCT NO>
  9. CONTACT>                                                                                     PHONE>                                
  10. BUSINESS OR PERSONAL?>    
  11.  
  12. TRADE REFERENCE1>                                                          CONTACT>                          PHONE>
  13. TRADE REFERENCE2>                                                          CONTACT>                           PHONE>
  14. PRESENT CARRIER>                                                   EST. MONTLY LONG DISTANCE BILL>
  15. FED. TAX ID>
  16. ______________________________________________________________________________________
  17.                                                             800 SERVICE INFORMATION:
  18.  
  19. HOW MANY 800 NUMBERS>                                       MAIN BILLING TELEPHONE NO.>
  20.  
  21.                                                  LIST BELOW ALL 800 PHONE NUMBERS.  
  22.           AREA CODE   NUMBER             
  23. 1.                800   -                  
  24.           AREA CODE   NUMBER          
  25. 2.              800   -        
  26.           AREA CODE   NUMBER           
  27. 3.             800   -            
  28.           AREA CODE   NUMBER           
  29. 4.            800   -   
  30.  DO YOU WANT TO BE LISTED IN DIRECTORY ASSISTANCE?> 
  31. WHAT NUMBER WILL 800 RING IN ON?>
  32.  INTERNATIONAL 800?         YES>                   NO>
  33. AREA CODES OR STATES TO BE EXCLUDED IF ANY>
  34. CANADIAN 800?                       YES>                    NO>
  35. LISTING NAME PREFERRED>
  36. ____________________________________________________________________________
  37.                              
  38. I hereby authorize Affinity Fund, Inc. or their authorized representative to transfer my long distance line carrier.  I understand that my local operating company may charge a fee to perform the transfer.  I accept responsibility for all changes associated with the above telephone number.
  39.  
  40. _____________________________________________________________________________
  41. AUTHORIZED SIGNATURE                      TITLE               DATE                                              
  42.  
  43. ______________________________________________________________________________
  44. PRINT NAME
  45.  
  46. _____________________________________________________________________________
  47. ANI CONSULTANT SIGNATURE               CONSULTANT ID CODE:  747-0180
  48.  
  49. SEND COMPLETED REQUEST FORM TO:                         OR FAX TO:        (408) 423-0131
  50. LIGHTHOUSE PRODUCTIONS
  51. P.O. BOX 7885
  52. SANTA CRUZ, CA 95060
  53.  
  54.  
  55. Remember, this Long Distance calling Plan is GUARANTEED to save you at least 10% of your monthly Long Distance Bill.  If you can show that AFI did not save you at least 10% of your first month's Long Distance Charges with us, send us the bill and you will be paid your ENTIRE MONTHLY LONG DISTANCE CHARGES.  That's a guarantee that means something.  
  56.